Researchers test new ultrasound method for heart disease

By Kate Madden Yee, AuntMinnie.com staff writer

April 5, 2019 -- Researchers from the University of Arkansas in Fayetteville have published results from a study testing a new ultrasound imaging method for the detection and diagnosis of congenital heart disease in infants and children.

The new technology, called vector flow, creates images of the internal structure and blood flow of children's hearts. It was used for the first time in humans at the Arkansas Children's Hospital in Little Rock, according to a team led by Dr. Morten Jensen, PhD. The study was published March 5 in Progress in Pediatric Cardiology.

About 1% of babies are born with congenital heart defects. Pediatric cardiologists identify congenital heart disease using echocardiography and other processes based on ultrasound, the researchers wrote. Although effective, ultrasound can't accurately obtain details about blood flow within the heart.

The team used an ultrasound scanner with vector flow imaging to image the hearts of two three-month-old babies, one with a healthy heart and one with congenital heart disease. The technology allowed for complete transthoracic imaging of tissue and blood flow at a depth of 6.5 cm; abnormal flow and cardiac anomalies were clearly visualized in the child with congenital heart disease.

Vector flow imaging demonstrates swirl of blood flow within the dilated main pulmonary artery of a pig. Image courtesy of Dr. Morten Jensen, PhD.

"Vector flow imaging technology is not yet possible in adults, but we have demonstrated that it is feasible in pediatric patients," Jensen said in a statement released by the university April 3. "Our group demonstrated that this commercially available technology can be used as a bedside imaging method, providing advanced detail of blood flow patterns within cardiac chambers, across valves, and in the great arteries."

ABUS better than DBT for diagnostic workup.

By Kate Madden Yee, AuntMinnie.com staff writer

March 5, 2019 -- Automated breast ultrasound (ABUS) is more accurate than digital breast tomosynthesis (DBT) as a diagnostic tool for working up positive findings on mammography screening in dense breast tissue, according to a presentation delivered at ECR 2019.

ABUS does have limitations, notably microcalcifications and imaging the retroareolar area of the breast, said presenter Dr. Norran Hussein Said of Cairo University. But its benefits may outweigh them.

"ABUS has the capability of 3D assessment [of dense breasts], and can differentiate solid from cystic lesions," Said told session attendees.

The group used data from the Egypt Breast Cancer National Screening Program to compare the performance of ABUS to tomosynthesis in the workup of 242 women with dense breasts recalled after positive screening mammography. Positive findings included focal asymmetries, masses, distortions, or microcalcifications.

All of the women who participated in the study underwent both tomosynthesis and ABUS. The researchers compared exam results to pathology data.

Tomosynthesis vs. ABUS in women with dense breast tissue
Measure	Tomosynthesis	ABUS
Sensitivity	92%	92%
Specificity	92%	98%
Positive predictive value	76%	92%
Negative predictive value	98%	98%
Accuracy	92%	97%

"Our results show that most of our recalled cases consisted of masses, followed by asymmetries," Said told session attendees.

The two modalities agreed on true positives in 43 out of 51 proven cancers, and each modality had four false negatives. ABUS had four false positives, while tomosynthesis had 15. ABUS helped avoid 187 biopsies, while tomosynthesis helped avoid 176.

"In our study, ABUS showed a higher accuracy than DBT," Said concluded.

Works with 2D, too

In a related study, a Romanian team found that, when added to full-field digital mammography (FFDM), ABUS was an effective adjunct tool for finding cancer in women with dense tissue, specifically improving sensitivity and negative predictive value compared with FFDM alone.

Dr. Ioana Boca of Emergency County Hospital in Cluj-Napoca compared the performance of FFDM, 3D mammography, and ABUS for breast cancer detection in women with dense tissue. Two radiologists interpreted 127 ABUS exams procured after FFDM or 3D mammography. Their results were compared to histopathology for biopsied lesions, handheld ultrasound for benign lesions, and follow-up for benign lesions unchanged for at least two years. Nineteen cancers were identified.

ABUS boosted FFDM's sensitivity and negative predictive value, although it did not outperform 3D mammography in this screening context, Boca noted.

FFDM, FFDM + ABUS, and 3D mammography in dense tissue
	FFDM	2D mammography + ABUS	3D mammography
Sensitivity	77.8%	80%	100%
Specificity	100%	89.2%	86.4%
Positive predictive value	100%	71.4%	74.2%
Negative predictive value	92%	93%	100%

"In screening, ABUS added to FFDM compared with FFDM alone improved readers' detection of breast cancers in women with dense breast tissue," Boca concluded.